Performance-Enhancing Drugs On High Altitude Mountains – Doping or Life Saver?

Claire Weiss | ClimbingClimbing
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Khumbu icefall. Photo credit: National Geographic

In competitive sports, doping refers to the use of banned athletic performance-enhancing drugs by athletic competitors, where the term doping is widely used by organizations that regulate sporting competitions. The use of banned drugs to enhance performance is considered unethical, and therefore prohibited, by most international sports organizations, including the International Olympic Committee. Furthermore, athletes (or athletic programs) taking explicit measures to evade detection exacerbates the ethical violation with overt deception and cheating.

–Wikipedia

But what about mountaineering and climbing?

Even if we set aside the overall danger of climbing – slipping, loosing footage,falling, etc.,  one of the main danger for climber’s health and life is altitude sickness. Our body is not designed to function on high altitude, so when brought to the high mountain we can experience a broad range of symptoms, some of which could be even lethal, like HAPE (high altitude pulmonary edema) and HACE (high altitude cerebral edema).

What is altitude sickness and how it manifests?

 

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The cerebral effects of ascent to high altitudes. Image credit: TheLancet.com, 2009

Although oxygen dissolves in blood, only a small amount of oxygen is transported this way. Most oxygen, 98.5 percent, is bound to a protein called hemoglobin and carried to the tissues.

The oxygen level in the air is gradually diminished with altitude. As the partial pressure of oxygen decreases, less oxygen binds hemoglobin and less oxygen is transported to the tissues which results in hypoxia.

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Oxygen dissociation curve. Image credit: boundless.com

So, the oxygen transport is determined by the amount of hemoglobin in the blood (number of red blood cells) as well as affinity of hemoglobin to O2 which is reduced if blood PH decreases.

The major cause of altitude sickness is going too high too fast. Given time, your body can adapt to the decrease in oxygen molecules at a specific altitude. This process,known as acclimatization, generally takes 1-3 days at that altitude. For example, if you hike to 10,000 feet, and spend several days at that altitude, your body acclimatize to 10,000 feet. If you climb to 12,000 feet, your body has to acclimatize once again. A number of changes take place in the body to allow it to operate with decreased oxygen – hyperventilation (breathing faster, deeper, or both), shortness of breath during exertion, changed breathing pattern at night, awakening frequently at night etc.

The rule of thumb is “Climb high, sleep low”.

But sometime you don’t have enough time to acclimatization – this could be because of the weather window for summiting or not properly planned expedition.  Also for a very high altitude, especially “Death zone” (above 8000 meters where oxygen level is only ~30% ) on Mount Everest you just can’t acclimatize..

There are few preventive medicine known to help with altitude sickness.

  • Diamox (Acetazolamide) allows you to breathe faster so that you metabolize more oxygen, thereby minimizing the symptoms caused by poor oxygenation. This is especially helpful at night when respiratory drive is decreased (Cheyne–Stokes respiration ) Possible side effects include tingling of the lips and finger tips, blurring of vision, and alteration of taste. Side effects subside when the drug is stopped. Since Diamox is a sulfonamide drug, people who are allergic to sulfa drugs should not take Diamox. Diamox has also been known to cause severe allergic reactions to people with no previous history of Diamox or sulfa allergies(!!).
  • Dexamethasone (a steroid) is a prescription drug that decreases brain and other swelling reversing the effects of AMS. Dosage is typically 4 mg twice a day for a few days starting with the ascent. This prevents most symptoms of altitude illness. Side effects include an Addisonian crisis if stopped abruptly after more than a few days, Cushing’s syndrome if high doses are taken for a long time, mood changes, depression, hyperglycemia, peptic ulcer, gastric hemorrhage. Corticosteroid induced euphoria can decrease the ability to assess and manage risk in the mountains.

    ETHICS: For recreational mountaineering the use of corticosteroids has to be a personal decision but the risk/benefit equation is very different from acetazolamide since the potential side effects, interactions and problems are much greater.

  • Oxygen provides you most needed drug at high altitude.
  • Nifedipine is the drug of choice to buy time for the vital descent in the management of HAPE. As with any powerful potentially lifesaving drugs nifedipine has side effects. If used for prevention it cannot be used for treatment. If the patient is taking any other drug from the same calcium channel blocker class it should be avoided due to a combined effect on lowering blood pressure. The long list of recognized side effects in some people include dizziness, flushing, peripheral edema (potentially dangerous in tight boots predisposing to frostbite), insomnia, drowsiness and depression.
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Medicine used by mountaineers. Image credit: Romi Garduce

There were a long-time debates on should the usage of these drugs be considered ethical or cheating?

Dexamethasone is a lifesaver in cases of HACE when combined with oxygen and descent, and its use in those cases is absolutely not argued in the mountain medicine community. However, the question always comes up — climbers want to know whether they can safely use dex on ascent to feel better and climb faster.

— BaseCampMD.com

Abusing this drug could not only ruin your chances to summit but also possibly lead to death.

The story  about Jesse Easterling was first published by Outside magazine in 2013. He was going to summit Mount Everest in May 2009. He had developed a large lump on the back of his neck, and was so out of it that he couldn’t even remember his name. Eventually, the Everest doctors were able to ascertain the cause of Easterling’s disorientation: after a month on dexamethasone, a powerful anti-inflammatory steroid, he had stopped taking the drug cold turkey. This can shock to the body, enough to completely shut down the adrenal system and lead to multiple organ failure. That Easterling was still standing was a near miracle; if something wasn’t done immediately, he would soon be dead.

 

Other substances used by mountaineers:

(Full list of substances used in mountaineering in accordance with The International Mountaineering and Climbing Federation UIAA 2014 report can be found here )

  • Aspirin used for high altitude headache. Although easily available without prescription in many pharmacies around the world the adverse effects of Aspirin should not be underestimated. Its antiplatelet effect (decreases viscosity of blood) increases the risk of internal bleeding from the stomach and gut, brain, retina and respiratory system. It can cause indigestion and effect kidney function.
  • Beta blockers used to reduce the physical symptoms of stress and anxiety and for this reason they might be considered by sports climbers. Beta blockers reduce the maximum pulse rate and therefore maximal workload, can cause lethargy and decrease the circulation to the extremities potentially putting he person more at risk of frostbite.
  • Alcohol   – in even slight overdose it can mimic AMS or HACE. It also reduces reflex times, can interfere with physical balance and also impairs the ability to assess and manage risk. Its slow degradation in the body (0.12% per hour) means that these effects will persist if undertaking an early Alpine start to climb.
  • Amphetamines  – stimulant drug. There is a very real risk of overexertion if using these stimulants resulting in exhaustion, hypothermia, collapse and death.
  • Erythropoietin   – stimulate red blood cells production and as a result increase the ability to transport oxygen. Side effects are the risk of blood clots causing strokes or pulmonary emboli.
  • Opiates – used in some sports to mask pain. To some degree all can depress breathing, cause drowsiness, reduce reaction times and risk appreciation, induce constipation and are potentially addictive.
  • Viagra can inhibit the effect on hypoxic pulmonary resistance at altitude.

US doctor Luanne Freer is quoted in the UIAA report. In 2003, she founded the “Everest ER”, the highest infirmary in the world, located in Everest base camp. “We estimate that during our informal survey on Everest spring 2012, at least two-thirds of climbers we contacted were prescribed several performance enhancing drugs (PEDs) and had intent to use them not for rescue, but to increase their chances of summit success“ – said physician.

—  Adventure Sports with Stefan Nestler blog

Mountaineers have always had to make personal decisions regarding the use of climbing aids (eg, fixed ropes, supplemental oxygen, and so forth) and what constitutes climbing a mountain in “good style” versus cheating.

— WILDERNESS & ENVIRONMENTAL MEDICINE, 23, 205–206 (2012)

 

According to VICE Sports:

The World Anti-Doping Agency has set forth explicit rules on what does and doesn’t count as doping in mountaineering. Yet as Himalayan Database archivist Richard Salisbury told VICE Sports, there’s no one around to enforce those rules. Moreover, determining whether dex was used for legitimate reasons during a climb can be tricky. Again, climbing is different. “[Doping] is fairly easy for the climbing world to do it because they carry dexamethasone as a first aid medicine,” said Mike Trueman, a professional mountaineer with over four decades of climbing experience. “Unlike most sports, we actually carry the performance-enhancing drug with us to begin with.”

 

 

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Mount Everest. Photo credit: RMI guides

 

The article in Outside magazine paints a picture of a mountain overrun by amateur and professional mountaineers using dex as a performance enhancer, doping their way to successful summits. But is this really the case?

Tell us what do you think.  

Should climbers use performance-enhancing drugs or not? Did you use any of these medicines while on the climb?

 

 

 

 


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2 thoughts on “Performance-Enhancing Drugs On High Altitude Mountains – Doping or Life Saver?

  1. EPO, if you’re gonna risk your life at very high altitudes, another $1000 is nothing in regards to the cost and enjoyment of your expensive journey.

    VA:F [1.9.22_1171]
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  2. in most sports it’s: I was close but my fast ball wasn’t fast enough….or, I just don’t have the ….whatever. and you face up and do something else with your life. but to fake that you are a bad ass climber when you have a genetic weakness for the whole altitude thing is wrong…weak. some guys practically run up and down that mountain without gas. why? because they are the true bad asses. most people on that mountain should not be there….nature says so…they are w-e-a-k.

    VA:F [1.9.22_1171]
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